1
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Jiang R, Li X, Cao S, Wu Y, Zhang W, Huang Y. Nodal staging score for adequacy of nodal staging in cervical cancer. Heliyon 2024; 10:e26116. [PMID: 38596019 PMCID: PMC11001770 DOI: 10.1016/j.heliyon.2024.e26116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 04/11/2024] Open
Abstract
Background Cervical cancer remains the fourth most common female malignancy with increasing newly cases around the world. It is of clinical value to precisely evaluate whether false negative nodal existed and develop a nodal staging model in cervical cancer. Materials and methods Clinical data of cervical cancer patients was retrieved from the Surveillance, Epidemiology, and End Results database. Probability of missing nodal disease and nodal staging score (NSS) was computed to assess the nodal status of each individual.Prognostic value of NSS was assessed. Results A total of 9056 individuals were in this study, with 5115 squamous cell carcinoma, 2791 adenocarcinoma, 512 adenosquamous carcinoma, and 638 other type individuals. A beta-binomial model was used to compute the probability of nodal disease in four histological types, respectively. False negative probability drastically decreased as more nodes examined. To reach 0.05 of false negative probability, it required at least 17 lymph nodes in squamous cell carcinoma patients,18 in adenocarcinoma, 12 in adenosquamous carcinoma patients and 14 in other types. To reach 0.95 of NSS, it took 10 lymph nodes in squamous cell carcinoma, 6 in adenocarcinoma, 10 in adenosquamous carcinoma and 7 in other types. Significant prognostic values of NSS quartiles subsets were found in all four histological sets. Conclusion NSS tool enables adequate nodal staging of cervical cancer with significant prognostic value. Exact number of lymph nodes required for surgery in cervical cancer is specified based on histologic type.
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Affiliation(s)
- Rui Jiang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Xiaoqi Li
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Siyu Cao
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Yong Wu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Wei Zhang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Yan Huang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
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2
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Matsas A, Christopoulos P, Karachalios C, Savranakis O, Marinos L, Vlahos NF, Panoskaltsis T. Primary follicular lymphoma of the uterine cervix: A case report. Oncol Lett 2023; 25:251. [PMID: 37153041 PMCID: PMC10161347 DOI: 10.3892/ol.2023.13837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/13/2023] [Indexed: 05/09/2023] Open
Abstract
Primary non-Hodgkin lymphoma of the uterine cervix is a rare clinical entity. The present case report describes an incidence of primary cervical follicular lymphoma, diagnosed during management of concurrent cervical intraepithelial neoplasia. The present case report outlines not only the necessity of adhering to guidelines regarding the management of abnormal cervical cytology, but also the importance of expert pathological review and the need for personalized management.
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Affiliation(s)
- Alkis Matsas
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece
- Laboratory of Experimental Surgery and Surgical Research ‘N.S. Christeas’, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece
| | - Charalampos Karachalios
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece
| | - Orestis Savranakis
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece
| | - Leonidas Marinos
- Hematopathology Department, Evangelismos General Hospital, 10676 Athens, Greece
| | - Nikos F. Vlahos
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece
| | - Theodoros Panoskaltsis
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece
- Correspondence to: Professor Theodoros Panoskaltsis, Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, Vas. Sofias 76, 11528 Athens, Greece, E-mail:
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3
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Weng X, Huang M, Zhang M, Yang Y, Liu X, Huang Y. Primary lymphoma of the uterine cervix: a clinicopathologic study of 13 cases with review of additional 54 cases in the literature. Virchows Arch 2023; 482:419-429. [PMID: 36350409 DOI: 10.1007/s00428-022-03436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
Primary lymphoma of the uterine cervix (LUCX) is extremely rare, and its diagnosis is challenging. However, its clinicopathological features have not been well characterized. Thirteen primary LUCX patients were retrospectively studied, and 54 patients from the literature were reviewed. Primary LUCX was identified in 0.22% (13/6000) of patients with uterine cervical malignancies in our institution. The patients' median age was 51 years (range: 22-85 years). All patients had a bulk of neoplasms in the uterine cervix. The median tumour diameter was 6 cm (range: 1.5-10 cm). Approximately 78.0% (39/50) of the patients initially presented with irregular vaginal bleeding or discharge. Moreover, 86.7% (39/45) had Ann Arbor stage I or II. Diffuse large B-cell lymphoma, not otherwise specified, was the most common type, accounting for 85.0% (57/67) of primary LUCX cases. Follicular lymphoma (7.5%, 5/67), extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (4.5%, 3/67), mantle cell lymphoma (MCL), blastoid variant (1.5%, 1/67), and peripheral T-cell lymphoma (1.5%, 1/67) were occasionally observed. Three patients (7.1%, 3/42) with DLBCL, NOS died from the disease during the follow-up period. Their 5-year overall survival (OS) rate was 93.5%. The patient with MCL, blastoid variant in our present cohort died of the disease 33 months after diagnosis. Primary LUCX is an extremely rare condition. The clinical symptoms are non-specific. DLBCL, NOS is the most common histologic type, showing a favourable outcome with accurate diagnosis and timely and optimal treatment.
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Affiliation(s)
- Xin Weng
- Department of Pathology, Shenzhen Second People's Hospital, Shenzhen University First Affiliated Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Mayan Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.,Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Meng Zhang
- Department of Pathology, Shenzhen Second People's Hospital, Shenzhen University First Affiliated Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Yajie Yang
- Department of Pathology, Shenzhen Second People's Hospital, Shenzhen University First Affiliated Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xia Liu
- Department of Pathology, Shenzhen Second People's Hospital, Shenzhen University First Affiliated Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Yuhua Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China. .,Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.
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4
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Gao L, Chen X, Zhao J, Xu A, Liu M, Yu H, Kong S, Li S. Advanced Ann Arbor stage and age over 60 years as prognostic predictors in patients with primary cervical lymphoma: a retrospective cohort study and systematic review. BMC Cancer 2023; 23:95. [PMID: 36707772 PMCID: PMC9881271 DOI: 10.1186/s12885-023-10548-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To evaluate the overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) for primary cervical lymphoma (PCL), an extremely rare disease without treatment consensus. METHODS We conducted a retrospective study included 177 patients, including 169 cases identified from literature review. The Kaplan-Meier methods and Cox regression were used to determine the OS, DSS, RFS, and relevant risk factors. RESULTS The 5-year OS and 5-year DSS rates were 85.8 and 87.2%, respectively, while the 5-year RFS rate was 85.5%. Diffuse large B-cell lymphoma (DLBCL) was the predominant subtype that comprised 63.8% (113 cases) in this cohort. Multivariate analysis in the DLBCL subgroup revealed that age ≥ 60 years (Odds ratio [OR]: 26.324, 95% Confidence Interval [CI]: 5.090-136.144, P < 0.001) or stage IIIE-IVE (advanced stage) (OR: 4.219, 95%CI: 1.314-13.551, P = 0.016) were the risk factors for OS, while patients with age ≥ 60 years (OR:23.015, 95%CI: 3.857-137.324, P = 0.001), and stage IIIE-IVE (OR: 4.056, 95% CI: 1.137-14.469, P = 0.031) suffered a poor DSS. Chemotherapy and/or radiotherapy improved the OS (P = 0.008), DSS (P = 0.049), and RFS (P = 0.003). However, cancer-directed surgery did not improve the OS, DSS, and RFS. The risk factor was unavailable in other subtypes of PCL due to limited cases. CONCLUSION The survival outcomes in patients with PCL at early stage were satisfactory, while the advanced disease stage and age ≥ 60 years were the two major factors predicting poor prognosis in DLBCL subtype.
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Affiliation(s)
- Lingyun Gao
- grid.440323.20000 0004 1757 3171Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong People’s Republic of China
| | - Xiaoran Chen
- grid.440323.20000 0004 1757 3171Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong People’s Republic of China
| | - Jing Zhao
- grid.440323.20000 0004 1757 3171Department of Hematology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong People’s Republic of China
| | - Anli Xu
- grid.440323.20000 0004 1757 3171Department of Obstetrics and Gynecology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong People’s Republic of China
| | - Meijuan Liu
- grid.440323.20000 0004 1757 3171Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong People’s Republic of China
| | - Hongna Yu
- grid.440323.20000 0004 1757 3171Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong People’s Republic of China
| | - Shujun Kong
- grid.440323.20000 0004 1757 3171Department of Obstetrics and Gynecology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong People’s Republic of China
| | - Sijian Li
- grid.413106.10000 0000 9889 6335Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
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5
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M L, Busmanis I. Cause of vaginal spotting in an older woman. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:386-387. [PMID: 35786763 DOI: 10.47102/annals-acadmedsg.2022122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Logaswari M
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
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6
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Primary Non-Hodgkin Uterine Lymphoma of the Cervix: A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010106. [PMID: 35056415 PMCID: PMC8780590 DOI: 10.3390/medicina58010106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 12/26/2022]
Abstract
Introduction: Non-Hodgkin lymphomas (NHL) comprise 85% of the total lymphomas diagnosed, with the histological type of diffuse large B-cell lymphomas (DLBCL) being the most prevalent in adults. In about 40% of cases, the location is extranodal. Uterine cervix lymphomas of this type are extremely rare (0.5–1.5%) and represent a diagnostic challenge. A case of DLBCL of the cervix is presented here along with a review of the literature. Materials and methods: A 75-year-old patient was referred with a bleeding vegetant tumour occupying her entire vagina. The histological and pathological investigations performed following the tumour biopsy indicated a malignant, diffuse, vaguely nodular lymphoid tumour proliferation. The immunohistochemistry results were in favour of a diffuse B-cell non-Hodgkin lymphoma (DLBCL). CHOP (Cyclophosphamide, Hydroxydaunorubicin (also called doxorubicin or adriamycin), Oncovin (vincristine), Prednisone or Prednisolone) polychemotherapy and radiotherapy were effective and resulted in tumour regression (from 3.4 cm to tumour disappearance, with the cervix returning to normal size). Conclusions: The uterine cervix lymphoma prognosis is more conservative than that for a nodal lymphoma, mainly due to a later diagnosis determined via immunohistochemistry. Chemotherapy is the main treatment.
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7
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Menon PD, Tariq H, Forker C, Nazarullah A. Diagnosis of uterine lymphoma on cervical pap smear: Case report and review of literature. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2020.200466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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8
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Goda JS, Gaikwad U, Narayan A, Kurkure D, Yadav S, Khanna N, Jain H, Bagal B, Epari S, Singh P, Sengar M, Laskar S. Primary diffuse large B cell lymphoma of Uterine Cervix: Treatment outcomes of a rare entity with literature review. Cancer Rep (Hoboken) 2020; 3:e1264. [PMID: 32761885 DOI: 10.1002/cnr2.1264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Primary lymphomas involving the female genital tract are rare, and those arising from cervix are extremely uncommon. They are often misdiagnosed because of their rarity. METHODS AND CASES The treatment and clinical outcomes of the four cases treated at our institution were compared with the previously published studies. Written informed consent was taken. We highlight four cases of primary diffuse large B-cell lymphoma of cervix treated at our institution with immunochemotherapy and radiotherapy. The mean age was 50 years (range, 39-62 years). Three patients had stage I disease while one had stage II disease. All the patients were in complete remission following treatment with immunochemotherapy and radiation therapy. The average disease free survival was 20 months (range, 8-43 months). None of the patients had any local or systemic relapse. CONCLUSION These cases highlight the physicians to be aware of this entity as their management, natural history and prognosis is completely different from squamous carcinomas of the cervix. Surgery should not be attempted in these patients. Immunochemotherapy and radiotherapy results in favorable clinical outcomes.
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Affiliation(s)
- Jayant Sastri Goda
- Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Utpal Gaikwad
- Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Anand Narayan
- Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Durva Kurkure
- Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Subhash Yadav
- Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Nehal Khanna
- Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Hasmukh Jain
- Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Bhausaheb Bagal
- Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Sridhar Epari
- Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Priya Singh
- Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Manju Sengar
- Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Siddharth Laskar
- Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
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9
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Mohammed Saeed D, Patel P, Guzman G, Ni H. A Case of Classic Hodgkin Lymphoma Involving the Uterine Cervix Presenting As Vaginal Spotting. Cureus 2020; 12:e8889. [PMID: 32742856 PMCID: PMC7388806 DOI: 10.7759/cureus.8889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/27/2020] [Indexed: 11/15/2022] Open
Abstract
Classic Hodgkin lymphoma (CHL) is a clonal lymphoid neoplasm derived from B cells. CHL usually involves the lymph nodes. Although cases with extranodal involvement by CHL have been reported, the involvement of the uterine cervix by CHL is an extremely uncommon phenomenon. Herein, we report an unusual case of a 51-year-old female with nodular sclerosis CHL, diagnosed initially via right inguinal lymph node biopsy. After two cycles of chemotherapy, she presented with vaginal spotting and CT scan demonstrated a uterine cervical lesion with hypermetabolic activity. Tissue biopsy sections of the uterine cervix showed cellular infiltrate consisting of large atypical cells including many lacunar cells and occasional Reed-Sternberg cells in the background of mixed reactive cells including small- to medium-sized lymphocytes, histiocytes, plasma cells, eosinophils, and neutrophils. Immunohistochemical stains show that the large atypical cells are positive for CD30, CD15, MUM-1, and weakly positive for PAX-5. In situ hybridization for Epstein-Barr virus-encoded RNA (EBER) is negative. The morphological and immunohistochemical findings were consistent with involvement by nodular sclerosis CHL. This case demonstrates a rare presentation of CHL that may pose a diagnostic problem if its existence is not considered in the differential diagnosis. Furthermore, we reviewed the literature and only found two previous publications described uterine cervix involvement by CHL. Although it is very rare, CHL involvement should be included in the differential diagnosis and an appropriate work-up should be performed to evaluate CHL involvement of cervix when patients with CHL present with signs or symptoms suggesting a cervical lesion.
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Affiliation(s)
| | - Pritesh Patel
- Hematology and Oncology, University of Illinois at Chicago, Chicago, USA
| | - Grace Guzman
- Pathology and Laboratory Medicine, University of Illinois at Chicago, Chicago, USA
| | - Hongyu Ni
- Hematopathology, University of Illinois at Chicago, Chicago, USA
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10
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Abstract
OBJECTIVE. In this article, we provide an updated review on the role of imaging in initial staging, treatment monitoring, and follow-up of cervical cancer with a focus on the role of MRI and FDG PET/CT. In addition, the 2018 International Federation of Gynecology and Obstetrics staging system and its implication on management of cervical cancer are explored. CONCLUSION. Imaging plays a major role in treatment planning and as a prognostic indicator in patients with cervical cancer. MRI and PET/CT have complementary roles: MRI is essential for the local staging of the primary tumor, and PET/CT is the most useful modality for detecting regional nodal and distant metastases.
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11
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Heremans R, Froyman W, Beckers M, Tousseyn T, Timmerman D. Advanced Doppler imaging and trucut biopsy of a late-stage cervical lymphoma. Australas J Ultrasound Med 2019; 22:301-304. [PMID: 34760573 DOI: 10.1002/ajum.12177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/08/2022] Open
Abstract
Extranodal lymphomas of the cervix are rare entities that are often misdiagnosed. Imaging and tissue diagnosis are a key to early identification and differentiation from other types of cervical lesions. We report on a case of cervical lymphoma, assessed with three-dimensional Doppler-augmented Radiantflow™ technology and subjected to deep cervical sampling through trucut core needle biopsy.
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Affiliation(s)
- Ruben Heremans
- Department of Development and Regeneration KU Leuven Leuven Belgium.,Department of Obstetrics and Gynaecology University Hospitals KU Leuven Leuven Belgium
| | - Wouter Froyman
- Department of Development and Regeneration KU Leuven Leuven Belgium.,Department of Obstetrics and Gynaecology University Hospitals KU Leuven Leuven Belgium
| | - Mariëlle Beckers
- Department of Haematology University Hospitals KU Leuven Leuven Belgium
| | - Thomas Tousseyn
- Department of Pathology University Hospitals KU Leuven Leuven Belgium
| | - Dirk Timmerman
- Department of Development and Regeneration KU Leuven Leuven Belgium.,Department of Obstetrics and Gynaecology University Hospitals KU Leuven Leuven Belgium
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12
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Petry KU, Liebrich C, Luyten A, Zander M, Iftner T. Surgical staging identified false HPV-negative cases in a large series of invasive cervical cancers. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 4:85-89. [PMID: 29179875 PMCID: PMC5883200 DOI: 10.1016/j.pvr.2017.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We examined a large series of biopsy-proven invasive cervical cancers with surgical staging and HPV re-testing to estimate the relevance of HPV-negative cervical cancers in a Caucasian population. METHODS We prospectively collected smears from 371 patients with a biopsy-proven diagnosis of cervical cancer for HC2 testing of high-risk HPV (HR-HPV). In HC2-negative cases, smears and paraffin embedded tissue blocks underwent additional HPV genotyping. RESULTS HC2 tests showed 31/371 cases (8.8%) had negative findings. Surgical staging showed that 21/31 HC2-negative cases (68%) were not cervical cancer. Overall, 340/350 cases of primary cervical cancer confirmed by surgical staging tested HC2 positive (97.2%). Non-high-risk HPV subtypes were detected in five cases (one HPV-53, one HPV-70, and three HPV-73) and high-risk subtypes in four patients with HC2-negative cervical cancer (two HPV 16 and two HPV-18). The remaining case, a primary undifferentiated carcinoma of the uterine cervix, tested negative for HPV-DNA with all tests. CONCLUSIONS The main explanation for HPV-negative cervical cancer was a false diagnosis, followed by cancers associated with non-HR-HPV types, and false-negative HR-HPV results. Truly HPV negative seem to be very rare in Caucasian populations. Retrospective analyses without surgical staging may overestimate the proportion of HPV negative cervical cancers.
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Affiliation(s)
- Karl Ulrich Petry
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany.
| | - Clemens Liebrich
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Alexander Luyten
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Martina Zander
- Institute of Pathology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Thomas Iftner
- Institute of Experimental Virology, University of Tübingen, Germany
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